On January 28, 2013, Canada will celebrate 25 years of reproductive freedom. Since our Supreme Court struck down Canada’s abortion law in 1988, our country’s experience is proof that laws against abortion are unnecessary. A full generation of Canadians has lived without a law and we are better off because of it.

Canada is the first country in the world to prove that abortion care can be ethically and effectively managed as part of standard healthcare practice, without being controlled by any civil or criminal law. Our success is a role model to the world. History: Previous laws and one Doctor’s civil disobedience In the 1988 Morgentaler decision, the Supreme Court of Canada ruled that our criminal law on abortion violated the constitutional right to “security of the person” under our Charter of Rights and Freedoms. One justice, Bertha Wilson, also found that women’s rights to life, liberty, conscience, privacy, and autonomy were compromised by the law. She stated that every individual must be guaranteed “a degree of personal autonomy over important decisions intimately affecting his or her private life. Liberty in a free and democratic society does not require the state to approve such decisions but it does require the state to respect them.”

The struck-down law was a liberalized one that passed in 1969, replacing a strict ban on abortion. The 1969 law required women to apply for permission from a hospital committee, which would decide if a woman’s health or life was at risk. The law obstructed access for women because most hospitals did not even establish committees, while some that did refused to approve most or all applications. In practice, access to abortion was spotty and unfair. Long delays at hospitals also increased the health risks for many women. Abortion clinics were illegal.

Dr. Henry Morgentaler had begun performing safe — but illegal — abortions in his private office in Montreal in 1968, a year before the new law passed. In 1967, he told a Parliamentary committee that women had a right to abortion on request without having to state a reason. After the 1969 law passed, he continued to break the law because he knew that sending women to a committee for approval was a discriminatory barrier that increased medical risks to women.

During his 20-year battle, Dr. Morgentaler challenged the law by opening illegal abortion clinics in three cities and inviting media coverage of his safe abortion services. Police raided the clinics several times, resulting in repeated arrests and trials that eventually led to the historic Supreme Court victory on January 28, 1988.

Reaping the benefits of decriminalization

The evidence now vindicates Dr. Morgentaler’s perspective and Canada’s legal position. After 25 years with no legal restrictions on abortion whatsoever:

– Doctors and women handle abortion care responsibly. - Abortion rates are fairly low and have steadily declined since 1997. - Almost all abortions occur early in pregnancy. - Maternal deaths and complications from abortion are very low. - Abortion care is fully funded and integrated into the healthcare system (improving accessibility and safety). - Further legal precedents have advanced women’s equality by affirming an unrestricted right to abortion. - Public support for abortion rights has increased. Responsible abortion care: Since 1988, the Canadian Medical Association (CMA) has successfully managed abortion just as it does for every other medical procedure — by applying policy and encouraging medical discretion for doctors, subject to a standard code of ethics.

Doctors abide by CMA policy and guidelines, and follow best medical practices based on validated research and clinical protocols. Criminal laws are inappropriate and harmful in medicine because they constrain care and negatively impact the health of patients. Low and declining abortion rates: Canadian women had 93,755 abortions in 2009 — the last year for which reliable numbers are available. This translates to an annual abortion rate of 14 per 1000 women of childbearing age, approaching the lowest rates in the world. Incidentally, the annual abortion rate in the United States has also declined significantly in the last decade, and now sits at 15 abortions per 1000 women of childbearing age.

Although western European countries and the U.S. enforce various legal restrictions on abortion care, their declines in abortion rates are not attributed to the effect of laws, but largely to more effective and increased use of contraceptives. The evidence is clear that contraception and family planning services are key to reducing unintended pregnancy, which is the main cause of abortion. In countries where abortion is legal and contraceptive use improves over time, abortion rates decline predictably and often dramatically. This pattern has repeated itself countless times around the world, including in Canada, where our abortion rate has declined by at least 14 per cent since 1997, and by 29 per cent amongst teenagers. Earlier abortions: At least 90 per cent of abortions in Canada are now performed on request in the first 12 weeks. The procedure is very safe and 97.6 per cent of terminations (in hospitals) have no complications. Less than 2 per cent of abortions occur after 20 weeks (again in hospitals only), and these are performed only in cases of severe fetal anomaly or under compelling maternal life or health circumstances. A similar situation exists in every country independently of any laws — the majority of women seeking abortions will present early, while a small number of women will always need later abortions because of exceptional circumstances.

Low complication and death rate: About half of abortions are now done in private clinics in Canada, virtually all by 16 weeks of pregnancy. Since early abortions are safer than later abortions, and hospitals handle the later and more complex cases, our hospital statistics likely overestimate the number of later abortions, as well as maternal deaths and complications from abortion. Statistics Canada reported that in 1995, less than 1 per cent of abortions in Canada resulted in any complication at all, whether minor or more serious. Further, Canada has one of the world’s lowest maternal mortality rates from legal abortion. Between 1976 and 1994, the mortality rate was estimated to be 0.1 deaths for every 100,000 abortions — about one every ten years — compared to a rate of 0.7 in the U.S (from 1988 to 1997). Maternal death from legal abortion remains virtually unheard of in Canada today. Funding and integration into healthcare system: Abortion care has become better integrated into the Canadian healthcare system, partly because it was already being done in hospitals and funded as “therapeutic abortion” before 1988. However, between 1988 and 2006, the pro-choice movement successfully challenged provincial governments to also fund all procedures done at private clinics. Today, only the province of New Brunswick refuses to pay for abortions at one private clinic, in defiance of federal law. (The Canada Health Act guarantees funding and equitable access for all “medically required” treatment, which includes abortion.) Full government funding for abortion is essential to protect women from discrimination, facilitate early access, ensure acceptable standards of care, and prevent the service from becoming marginalized or further stigmatized.

Further legal precedents: Subsequent court rulings have solidified the Morgentaler decision, which has been widely cited in other rulings due to its advancement of women’s constitutional rights. The Supreme Court appears to have adopted Justice Wilson’s broader approach to such rights, recognizing for example that the right to liberty includes the autonomy to make decisions of fundamental personal importance. Our federal Criminal Code states that the legal status of “human being” accrues only after exiting the birth canal alive, a definition validated by several Supreme Court decisions that established that fetuses are not legal persons and that women’s rights must prevail. In a 1999 decision, Dobson v. Dobson, the Supreme Court ruled that: “A pregnant woman and her foetus are physically one, in the sense that she carries her foetus within herself. The physical unity of pregnant woman and foetus means that the imposition of a duty of care would amount to a profound compromise of her privacy and autonomy.”

Increased public support: Strong public support exists for abortion rights in Canada, despite lingering social stigma against abortion that is continually reinforced by anti-choice propaganda. Even though half of Canadians appear to want some restrictions on abortion, this anti-choice article on polling shows a gradual increase in pro-choice support since the 1980’s. A 2012 poll revealed that 49 per cent of Canadians support abortion on request at any time, while only 6 per cent want a total ban. (In comparison, 30 per cent of Americans want it fully legal while 15 per cent prefer a total ban.)

Having no laws is not enough

Of course, the lack of restrictive laws alone does not guarantee access or availability of services. Canada still has problems with access because of ongoing abortion stigma, inadequate training in medical schools, reluctance of politicians to implement improvements, and simple geography — abortion is much easier to access in larger cities than in Canada’s vast rural areas and North, where women often must travel to find abortion care. However, another benefit of decriminalization is that we have been able to focus our time on addressing these issues instead of struggling against restrictive laws.

Key to understanding the incidence of abortion is that it can never be eliminated. We will never live in a perfect world — contraception is far from 100 per cent effective, people are human, and continuing inequality means that disadvantaged women will experience higher rates of unintended pregnancy. The lowest possible abortion rates — the rates of 6 to 7 per 1000 women of childbearing age that were achieved in the past by Holland and Belgium — require a sustained commitment and dedicated resources in areas such as family planning and reproductive health services, comprehensive sex education, and doctor training. The other key element in reducing abortion is to advance women’s status and equality so they are more empowered to avoid unintended pregnancy.

Vigilance is also required due to the endless tenacity of the anti-choice movement. Since 1988, Canada has seen 45 attempts to recriminalize or restrict abortion through the introduction of Private Members Bills or Motions in Parliament. Not one has passed, and nor is one likely to pass. Despite the loud voices and campaigning power of anti-choice activists, women’s rights are well established in Canada and sexual and reproductive health is understood as a vital facet of overall health.

The moral high road: Decriminalizing abortion

The rest of the world is catching up to Canada. Two Australian states have also successfully decriminalized abortion in recent years. And in 2011, a groundbreaking report to the United Nations boldly called on all states to decriminalize abortion. The UN’s Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health described laws restricting abortion as an abuse of state power. Such restrictions “infringe human dignity by restricting the freedoms to which individuals are entitled under the right to health, particularly in respect of decision-making and bodily integrity.”

Looking at Canada, concerns that other countries may have about eliminating punitive laws on abortion are clearly unfounded. Even with our remaining issues, our outcomes are exemplary. We can all thank Henry Morgentaler for that.

The Canadian pro-choice movement will do all it can to ensure that Canada never goes back, and we encourage other countries to embark upon a similar journey. When women can make their own reproductive decisions without interference from the state, society takes the moral high road — one that saves lives, raises women’s status and potential, and ultimately benefits everyone.

Joyce Arthur is the founder and Executive Director of Canada’s national pro-choice group, the Abortion Rights Coalition of Canada (ARCC), which protects the legal right to abortion on request and works to improve access to quality abortion services.

The author would like to thank Jane Cawthorne for contributing to this article.

Savita Halappanavar’s life ended because medics put the life of her unborn child – who they knew would die anyway – before hers, and because those medics were prevented by law from performing a procedure that would have saved her.

This week I’ve been thinking a lot about the tragic death of Savita Halappanavar, the 31 year old dentist who passed away in a Galway hospital last month, after being refused an abortion that could have saved her life. By the time this goes live, I’m sure the controversy will have reached Frankenstorm proportions.

Halappanavar was admitted to hospital miscarrying at 17 weeks. However, abortion is illegal in Ireland, and because the foetal heartbeat was still beating, medics refused to perform the medical abortion she needed and begged for. She miscarried days later, but not before she’d contracted the septicemia that would go on to kill her.

Anti-choice campaigners may rabbit on about the provision under law that states that abortion can be provided when there’s a direct threat to a woman’s life, or claim that the medics looking after Halappanavar should have induced labour in order to save her life.

The reality, as we’ve now seen, is that abortions are just not performed. And as for their suggestion that medics should have induced the birth of her unborn, but dying foetus? It would have been both cruel and totally unnecessary when the foetal heartbeat could have been stopped as the first step of the abortion Halappanavar repeatedly asked for.

The fact is, her baby, sadly, was not going to survive no matter what course of action her doctors took. So why not opt for the one that would have saved her?

Last week, I was contacted by Joyce Arthur, who is the Executive Director of the Abortion Rights Coalition of Canada (ARCC). Arthur emailed members of the British media wanting to talk about Nadine Dorries’ recent attempts to reduce the time limits on abortions in Britain.

She explained that abortion had been fully decriminalised in Canada in 1988 because it was felt that the application of either civil or criminal laws to medicine was inappropriate.

Abortions are seen as a matter for women and their doctors, not law-makers and politicians, and the overall impact has been positive – abortion rates had fallen. Arthur also felt that Dorries, and her strategies, were ‘misguided.’

Happy to talk to anyone who describes Nadine Dorries as ‘misguided,’ I contacted her for an interview.

Who are the Abortion Rights Coalition of Canada, and what do you do?

The Abortion Rights Coalition of Canada is a national advocacy group for abortion rights so we do lobbying and education. We act on various issues, working with MPs, to protect the abortion rights that we have and also try and improve access to abortion in different ways.

What abortion services are freely available in Canada? Are they available on the Canadian National Health Service for free?

We do have universal healthcare [an equivalent to the NHS] so it is fully covered. In 1969, abortion was decriminalised to allow women to go before a therapeutic approval committee of three doctors to get approval before an abortion.

Abortions were available at some hospitals but it turned out that the committees were very arbitrary in how they made decisions so that law was completely struck down by our Supreme Court in 1988.

After that, access improved. Before 1988 abortions were funded [by the health service] and that continued. We had a fight over the next ten years of getting private abortion clinics, which had previously been illegal, funded.

In your email to me you said, “Parliamentary debate led by MP Nadine Dorries on reducing the time limit for abortion is misguided since criminal or civil law is inappropriate in medicine.”

Can you explain to us how the laws surrounding abortion in Canada works?

We don’t actually have any laws. Basically, abortion care is delivered just like any other healthcare. We don’t use civil or criminal law in healthcare normally. Healthcare is delivered by the medical profession and they have their internal policies, they have a code of ethics for doctors around informed consent, all the normal stuff like that.

Really what it comes down to is a decision between a woman and her doctor, and the doctor has discretion over what’s appropriate for each patient and what their own limits are, and so on and so forth. They decide whether they want to perform abortions, to what gestational length and all that kind of thing.

The Canadian Medical Association passed a policy around the time of the Morgenthaller decision in 1988. Briefly, the policy is on induced abortion. It says:

“Abortion on request is recommended up to twenty weeks, and after that under exceptional circumstances.”

It doesn’t really go into [what these “exceptional circumstances” might be]. It just leaves it up to the Doctor’s discretion.

In practice what happens is that very, very few Doctors in Canada perform abortions after twenty weeks. It’s obviously a more complex procedure – it’s more skilled, so not many doctors are trained in it to begin with, meaning it’s only available at a few centres.

In almost all cases, what usually happens, especially later on in pregnancy, an abortion is sought because of lethal foetal abnormalities, where the foetus can’t survive the birth. Other cases most often involve serious health or life endangerment problems for women.

And sometimes a late abortion might be performed in especially socially compelling circumstances, which would be at the discretion of a doctor. For example, if a very young girl was in denial about her pregnancy, or a sexual assault or a domestic abuse survivor sought an abortion. In situations like that though it’s on a case-by-case basis according to the Doctor.

How has the full decriminalisation of abortion affected women in Canada?
The overall effect was that abortion was kind of incorporated into a regular part of healthcare, and even though we also had stand-alone clinics doing abortions, hospitals still were doing the bulk of abortions at the beginning.

They still do almost half so I think having that hospital-based service is important for integrating abortion care into regular healthcare instead of having it so isolated the way it is in the United States, for example.

I think it’s also shown that it’s working – we’ve gone for 25 years without law and nothing bad has happened – women are not presenting for 9 month abortions so they can fit into their prom dress, and so on.

—-

Back to Ireland. Performing or procuring an abortion in Ireland is a criminal act, with persons found guilty of either risking life imprisonment.

Savita Halappanavar’s life ended because medics put the life of her unborn child – who they knew would die anyway – before the life of the woman in front them. Because those medics were prevented by law from performing a procedure that would have saved her, and because the politicians who have the power to legislate so that no woman ever has to go through this again have refused to.

On Wednesday, hundreds of people gathered in protest outside the Dail (Dublin’s equivalent to the House of Commons), to express outrage at this tragedy and, once again, demand the government decriminalize abortion in this country.

Surely this time, now that Ireland and its abortion laws are under international scrutiny, something has got to give.

I’m tweeting angrily about Savita, Dorries and the state of reproductive rights in Ireland @AlisandeF

OTTAWA – Stephen Harper says the Conservative government will never reopen the contentious debate about abortion rights in Canada as long as he’s prime minister.

Harper was responding to a growing storm of campaign controversy surrounding abortion-related comments made by a Tory candidate in Saskatchewan.

“In our party, as in any broadly based party, there are people with a range of views on this issue,” Harper said during a campaign event in Conception Bay South, N.L.

“As long as I’m prime minister, we are not reopening the abortion debate … this is not the priority of the Canadian people or of this government.”

Brad Trost told an anti-abortion group on the weekend that International Planned Parenthood Federation has been denied Canadian funding because it supports abortion.

The comments hit the Conservative tour like a lightning bolt, prompting Tory spokesman Dimitri Soudas to summon reporters in an effort to get ahead of the story.

Soudas sang the praises of the government’s G8 initiative on child and maternal health, offering it as evidence that the Conservatives are champions of women’s rights.

The Tories are willing to work with organizations that are willing to work with them, Soudas said, including the International Planned Parenthood Federation, which has indeed made an application for funding under the G8 initiative.

Federation spokesman Paul Bell, reached in London, said the group has had a “continuous relationship” with Canada for the last 40 years, during which they’ve received consistent funding – until recently.

A bid submitted in 2009 for a renewal worth $6 million a year over three years, the same arrangement that was in place for the previous three years, was unsuccessful, Bell said.

So the federation submitted an unsolicited bid through the G8 initiative last year, but it seems to have been stalled at the stage where it would have been reviewed by International Co-operation Minister Bev Oda.

“Clearly it didn’t get approval before the end of the financial year, which was the end of March,” Bell said.

“So for 2010 we didn’t get any funding. Now the election’s been called so there’s unlikely to be an movement on that.”

Trost, meanwhile, has been making efforts in recent months to block the federation’s funding, he added.

“It’s always a concern when a member of Parliament takes that course, but that happens in a number of countries. There are people who campaign against the work that we do.”

Soudas also said the government would work with “organizations like International Planned Parenthood that will focus its energy and efforts on the criteria that we have laid out.”

Despite Harper’s efforts, the issue is now back on the front burner of the election campaign, with less than two weeks before Canadians go to the polls.

The Tories have run the same tight, orchestrated campaign that delivered Harper to power in 2006.

But they are clearly moving to avoid a repeat of the 2004 election campaign gaffe that saw backbencher Cheryl Gallant compare abortion to the beheading of hostages in Iraq, spoiling Harper’s first attempt to win power, and giving the Liberals a minority government.

Dear Friends

As you may know, Canada is hosting the G8 & G20 meetings this June. As host to the meetings, the Canadian Prime Minister wants to make maternal health a priority. However, he does not want to include contraception nor access to abortion where it is legal, nor health care for women who have had an illegal abortion. NAF has prepared the attached letter and we are asking for as many organizations to sign-on to this letter. This will demonstrate to the Prime Minister that the international community believes that any maternal health initiative cannot exclude these elements.

Would you be willing to have your organization listed as an organization supporting the letter that we will send just before the meeting? Would you also be willing to circulate this letter to other organizations in Russia asking for their support. If they are willing to support the letter please have them get in touch with me dfowler@prochoice.org so I can add their organization’s name to the letter. I need to know by the end of next week if you are willing to have your organization listed to this letter.

I appreciate very much your help and support for this very important challenge. It is really important to have as many organizations as possible from the G8 countries sign on to this letter so I very much hoping you will agree to have your organization list.